Culture change in long-term care homes

In the fall of 2019, The Glebe Centre implemented the “Butterfly” model of improved long-term care. CARP Ottawa is advocating similar transformative culture change in Ontario’s long-term care system.

By Sue LeConte

If you want to see real change in Ontario’s long-term care homes, the Canadian Association for Retired Persons (CARP) Ottawa urges you to send this message on transformative culture change to your local MPP or city councillor – or forward this article to them. Here’s why.

The tragic loss of life in long-term care homes due to COVID-19 has exposed many of the problems that have plagued the system for many years.

Many strategies have been tried over the years to repair the system, including stronger policies and more regulations, investments in staff, support from specialists and increased oversight by government. However, it is evident that these haven’t been enough to fix the inherent weaknesses in the current system.

CARP Ottawa recommends a transformative culture change in the long-term care home system as the most effective means to improve the quality of life and care of residents and to deal with problems exposed by the current crisis.

A number of innovative models have embraced this culture change in the U.S., Europe, Australia and recently in Ontario. Examples are the Eden Alternative, Green House Project, Butterfly Homes and Hogewey Villages.

The common elements of these models have been:

  • Using a relationship-based approach to care, where resident, staff and families feel part of a community;
  • Setting up small home-like environments;
  • Providing more hours of direct care for residents;
  • Employing full-time, well-paid staff who are trained in empathy and culture change;
  • Recognizing families and caregivers as integral members of the team;
  • Engaging volunteers who are trained in empathy and culture change.

The benefits of these models include reductions in the use of medications, the number of aggressive incidents, hospital visits, food waste and staff sick time, while also showing an increase in positive interactions between staff, families and residents.

The Glebe Centre seized the opportunity to be a leader for transformative culture change for our long-term care homes in Ottawa when it decided to implement the Butterfly model in one of its units, a project that began last fall (see article by Susan Zorz).

There is a growing awareness of the pressing need for significant reform. We owe it to current and future residents to change a system that has not always provided them with safe, quality care focused on their individual needs.

For more information: changeltcnow@gmail.com

Sue LeConte is a member of CARP Ottawa Advocacy Working Group on Long-term Care and a former executive director of The Glebe Centre.


The Butterfly home area’s dining room at The Glebe Centre. The art on the walls was painted by residents.   PHOTOS: Tessa Burkholder

Meaningful care at The Glebe Centre: the Butterfly model

By Susan Zorz

The core principles of the Butterfly model of long-term care are to transform a task-based care approach to a more family-like care, to recognize that feelings matter most and to establish that the quality of the interactions among staff, residents and families are at the core of our service. In January, The Glebe Centre hosted our partners from the U.K. to start our training in this model through participation in outcome-based education that focuses on emotional intelligence.

Our main quality indicators include: improved quality of life for people who live with dementia; a reduction in the use of psychotropic medications; fewer falls; less reported pain; a reduction in the use of mealtime supplements; less staff absenteeism; and an increase in staff engagement and quality of work life.

We were excited to start the training and education and we were able to complete three modules. Unfortunately, we were sidelined by the global pandemic. Despite this setback, we recognize that to meet the needs and expectations of residents and families, it is essential that we continue our commitment to ensuring increased quality of life as our main indicator to achieving excellence in care. We are currently looking at ways to continue to implement this project while working within the restrictions that COVID-19 has imposed.

Susan Zorz is director of resident services at The Glebe Centre.

The Butterfly model of long-term care calls for family-like interactions and settings.

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